Scoliosis is a common spinal disorder in children and adolescents, usually occurring in school-age children or teenagers, and is often first discovered by parents or teachers or classmates, often without special discomfort, sometimes when looking in the mirror. The appearance of the disease often includes asymmetry on both sides of the back, skewing of the trunk to one side, unequal shoulders, and unequal legs. In more severe cases of scoliosis, the doctor may recommend surgery. However, children and parents often have great concerns about surgery, worrying about the risks and possible sequelae of surgery. So, when should surgery be performed for scoliosis? As we know, scoliosis results in a skewed trunk and an asymmetrical back that mainly affects the patient’s appearance, so the greater the angle of scoliosis, the more pronounced the change in appearance will be and the greater the need for surgical correction. Generally speaking, scoliosis with an angle greater than 40° will result in a more pronounced deformity in appearance and is already indicated for surgery, and if the child is young and has just started a period of rapid growth, there is a very high probability that the deformity will worsen, and surgery should be aggressively performed. Sometimes, although scoliosis is mild when it is first detected, it is aggravated faster during the review process, and if conservative treatment with braces is not effective, surgery should also be an option. Scoliosis can appear as a single curvature, double curvature, or even a triple curvature on x-rays, and generally speaking, the greater the number of curves, the higher the risk of aggravation and the more likely it is to require surgery. In addition, if abnormalities in the bony structure of the spine or in the neurological structure of the spinal cord are found during the examination, the scoliosis is likely to worsen rapidly and surgery should be considered. Of course, each patient with scoliosis will have different degrees of deformity, appearance and neurological function, and their desired outcome of treatment will be different, often requiring the most appropriate treatment to be chosen based on their characteristics, and whether or not surgery should still be seen in the hospital, and the doctor will decide on the treatment plan.